2014 TCS NYC Marathon Question Title * 1. What is your first name? Question Title * 2. What is your last name? Question Title * 3. At what email address would you like to be contacted? Question Title * 4. What is your street address? Question Title * 5. What is your preferred phone number? Question Title * 6. What is your gender? Female Male Question Title * 7. What is your date of birth? Month/Day/Year Date Question Title * 8. Who is your employer? Question Title * 9. Does your company have an employee matching gifts program? Yes No Question Title * 10. Did you apply to gain entry to the Marathon on your own this year? Yes No Question Title * 11. Are you applying to the Liver Life Challenge team as a participant or a supporter? Participant - I do not have a number on my own and will commit to raising at least $3,000 Supporter- I have my own number for the marathon and will commit to raising at least $500 Question Title * 12. All accepted applicants to the team will receive a link to register online and must be prepared to pay $100.00 non-refundable donation to confirm registration. Are you prepared to make this donation, if accepted? Yes No Question Title * 13. Please provide us with your T-shirt size. The training T-shirts are dri-mesh and unisex. Small Medium Large X-Large Question Title * 14. Have you ever raised funds for a charity organization through an endurance event? Yes No Question Title * 15. If so, for which event and which charity? How much did you raise? (Please be specific) Question Title * 16. If accepted to the Liver Life Challenge team, what will your fundraising goal be? There is a fundraising minimum of $3,000 for the TCS NYC Marathon. Raise $7,500 and become a Top Fundraiser to receive extra perks and prizes. Question Title * 17. What are your ideas for raising these funds? Please be as specific as possible. Question Title * 18. Are you an active runner? Yes No Question Title * 19. Are you confident that with training you can complete a marathon in less than 6 hours? Yes No Question Title * 20. Please list any previous involvement with the American Liver Foundation. Question Title * 21. What is your connection to Liver Disease? I have liver disease. I have a friend with liver disease. I have a family member with liver disease. I am a transplant recipient. I work in the healthcare field. Other (please specify) Question Title * 22. Please share your story with us. Why do you want to run with the Liver Life Challenge team and how did you choose us as your charity of choice? Provided information will not be viewed or printed outside of staff members reviewing applications. (Please be specific as possible. The Liver Life Challenge program is competitive, and detailed information will help us when reviewing applications.) Question Title * 23. Please provide us with any additional information you may want us to consider while reviewing your application. Done
